The cyberattack on Change Healthcare has fractured the country’s health care payment infrastructure. But it also exposed how complicated and vital these electronic pipes are.

Using terms like “clearinghouse” and “electronic data interchange” are quick ways to lose an audience. But Ben Handel, a health economist at the University of California, Berkeley, for the past 13 years, has become intimately familiar with that language. When the Department of Justice sued to block UnitedHealth’s acquisition of Change Healthcare in 2022 — a case the agency ultimately lost — Handel was the government’s witness to explain what could happen to the payments and clearinghouse markets if the deal went through.

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He didn’t get into health economics to study the payment plumbing system, but understanding basic concepts about companies like Change Healthcare can illuminate the gravity of what is going on now. For example, the cyberattack and resulting outage isn’t just leading to a cash crunch for providers. It’s also creating uncertainty about how to handle basic requests to approve drugs and care and verify patients’ insurance.

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